Medical
mistrust.
When a client doesn’t trust professionals, and has good reason not to.
Many disabled people arrive in therapy after years of being doubted, rushed or harmed by health services. Their mistrust may be the most accurate thing in the room. It can also be painful, limiting, and sometimes risky for their health. This case shows how different approaches would hear it, and why the therapist has to start by recognising that they are part of the same system.
What this is: a worked comparison of how several therapy approaches might respond to a disabled client’s mistrust of professionals.
Why it matters: treating earned mistrust as a symptom repeats the experience that caused it.
The sharpest reframe: the question is not “how do we get rid of the mistrust?” but “what would make trust reasonable here?”
One thing to take away: earn trust through what you do, such as transparency about notes, choice and consent, before you interpret it.
The short version
Mistrust of professionals can come from being disbelieved, from frightening or invasive treatment, from records that followed someone around, or from being sent to therapy as if their illness were psychological. It can be wise, and it can also cost the person care they need. Each therapy approach hears a different part of this. A good response starts by acknowledging that the mistrust may be earned, then asks what it is about now, and builds trust through concrete, checkable actions.
The case
Sinéad is 38. For more than ten years she had joint pain, dislocations and exhaustion, and was repeatedly told it was stress or anxiety. She was eventually diagnosed with hypermobile Ehlers-Danlos syndrome. Her GP has now referred her for talking therapy “to help with coping”.
In the first session she sits near the door, keeps her coat on and says: “No offence, but I don’t trust anyone in your line of work. The last time someone sent me to a psychologist, it was because they’d decided my pain was in my head.”
She asks what the therapist will write to her GP. Sinéad is a fictional teaching example, not a real person.
What each approach would look for
Theory comparisonThese summaries describe what each approach characteristically attends to. They are simplified for comparison. The “what it can miss” notes are this site’s disability-informed reading.
Trauma-informed practice
Prioritises safety, trustworthiness and transparency, choice, collaboration and empowerment, and recognises that services themselves can retraumatise.
“What would help this feel safer, even a little?”
What it can miss: that “safety” has to include the therapist’s place in the medical system, not only how the room feels.
Relational and psychodynamic
Notices how past relationships with professionals shape what Sinéad expects from this one, and treats the mistrust as something to understand together.
“What do you expect I’ll do with what you tell me?”
What it can miss: that the expectation may be accurate. Calling it transference before acknowledging it was earned can feel like more disbelief.
Mentalizing and epistemic trust
Draws on the idea of “epistemic trust”: whether someone feels able to trust what others tell them as relevant to them. Sees rebuilding it as part of what therapy does.
“When has a professional got it right for you?”
What it can miss: that some people and institutions really are untrustworthy. Low trust can be learning, not a deficit.
CBT
Looks at the predictions (“they’ll say it’s in my head”), what they lead Sinéad to do, and whether they fit every situation.
“What would tell you a professional was safe to trust?”
What it can miss: that the predictions are based on evidence. The task is discrimination between situations, not disputing the belief.
Person-centred
Offers genuineness and acceptance, and lets Sinéad set the pace of trust rather than asking her to trust first.
“You don’t have to trust me yet. What would you like to know about me?”
What it can miss: the structural reasons for mistrust, if it is treated only as a feeling in the room.
Narrative
Asks how the story “my body was called my mind” was written, and who had the power to write it.
“Who got to decide what your pain meant?”
What it can miss: the present-day systems still writing that story, such as referral letters.
Disability studies and epistemic injustice
Uses Miranda Fricker’s idea of testimonial injustice: being given less credibility because of who you are. Disabled people’s accounts of their own bodies are often discounted in this way.
“Whose account of your body was believed, and whose wasn’t?”
What it can miss: personal suffering and coping that need attention too.
Systemic
Looks at the referral pathway itself: why therapy was offered, what the GP expects, what will be shared and with whom.
“What did your GP say therapy was for?”
What it can miss: her inner experience, if the focus stays on the pathway.
Every lens catches something real. None of them, alone, tells the therapist what Sinéad’s mistrust is about today.
How Sinéad’s answer changes the picture
Our frameworkSuppose the therapist says: “That makes sense, given what happened. Can I ask what worries you most about being here?” Here are four answers Sinéad might give, mapped to this site’s Mine, Yours, Ours, System framework.
Answer A: why she was sent
“That this referral means my GP still thinks it’s psychological. That you’ll be part of proving it.”
Where the problem mostly sits: System, then Ours.
A helpful focus: being clear about the therapist’s position: therapy is not a test of whether her pain is real, and she decides the goals. If the referral letter framed it that way, she can say so, and the therapist can say what they will and won’t write.
Approaches that fit best: disability-informed, systemic and person-centred. See When Disability Gets Misread as Psychology.
Answer B: what will be written
“What you’ll put in your notes and letters. Every time something gets written down, it follows me.”
Where the problem mostly sits: System and Ours.
A helpful focus: transparency about records: what is written, who sees it, what goes to the GP, and offering to agree letters with her before they are sent. Trust built through checkable actions.
Approaches that fit best: trauma-informed and systemic.
Answer C: her body’s reactions
“Appointments themselves. I can’t sleep the night before. In the waiting room I feel sick and my mind goes blank.”
Where the problem mostly sits: Mine.
A helpful focus: trauma responses to medical settings: understanding them, and planning for appointments she needs. The mistrust is not the target; the distress is.
Approaches that fit best: trauma-informed work, CBT or EMDR for medical trauma if she wants it. See Medical Trauma.
Answer D: avoiding care
“I’ve stopped going to the doctor at all. Even when my shoulder came out last month, I just put it back myself.”
Where the problem mostly sits: Mine, with real health risk.
A helpful focus: both respect and concern. Her reasons are valid, and the therapist can still care that she is going without treatment. Work towards safer ways of getting care: a trusted clinician, an advocate, a written plan for appointments.
Approaches that fit best: trauma-informed and pluralistic, with practical advocacy.
Answer D shows the limit of simply validating. The therapist can agree that the mistrust was earned and still be honest about worrying for her health. Both belong in the room.
Asking before deciding
Illustrative dialogueNo offence, but I don’t trust anyone in your line of work.
None taken. From what you’ve said, you were told for years that real symptoms were in your head. It would be strange if you did trust me straight away.
So what are you going to write to my GP?
Good question. Right now I’d only confirm that we’ve met. I won’t send anything else without showing it to you first. And I don’t see my job as deciding whether your pain is physical. That’s already been answered.
Okay. That’s… not what I expected.
You don’t have to trust me today. You can watch what I actually do and decide. What would you want from this, if it were useful?
The therapist answers the practical question directly, names their position, and lets trust be earned rather than requested.
What earns trust
Practice- Transparency about records: say what you write, who sees it, and offer to agree letters before they go. In the UK, people also have a legal right to request copies of their records.
- Clarity about your role: say plainly that therapy is not a test of whether symptoms are real.
- Choice and control: she can pause, skip a topic, sit where she wants, keep her coat on, leave early.
- Consistency: do what you said you would. Trust is usually built through small things kept.
- Owning mistakes quickly: see Rupture and Repair.
How you’d know it helped
Feedback- Sinéad starts asking questions rather than testing the therapist with them.
- She disagrees openly, which is often a sign of more trust, not less.
- She reads a letter before it is sent and feels it describes her accurately.
- If Answer D applied, she gets care for an injury she would previously have managed alone.
- She can tell the difference between professionals who are safe and those who aren’t, rather than trusting all or none.
When the therapist gets it wrong
RepairImagine that in the second session the therapist said: “I wonder if you’re bringing your experiences with doctors into our relationship.” Sinéad went quiet and said, “Probably.” She didn’t book the next session.
I’ve been thinking about what I said last time. You told me you didn’t trust professionals, and I turned that into something about you before I’d really acknowledged that it was earned, and that I’m part of the same system that let you down.
It felt like being analysed for not trusting. Again.
That’s fair, and I’m sorry. I’d like to do it differently. You can see anything I write. You can tell me to stop if a question feels like that again. And if later on you want to look at how the past shows up between us, we’ll do that together, if you choose.
What changes as a result: notes and letters are shared and agreed. Sinéad has an agreed “stop” phrase. The formulation is rewritten to include years of testimonial injustice as a cause of mistrust, not a symptom of it. Interpretation of the relationship is put aside unless she invites it. An apology alone would not have been the whole repair.
Words you can use
For clientsMore scripts are in the Self-Advocacy Script Library and Questions to Ask Before You Start.
Questions worth carrying, as a therapist
Therapist Reflection- Did I hear the mistrust as a symptom before I heard it as information?
- Do I know why this client was referred, and how the referral was framed?
- Am I clear with clients about what I write and who sees it?
- Have I said plainly that I am not judging whether their symptoms are real?
- Did validating the mistrust stop me noticing a real risk to their health?
- How do I respond when a client tests me? Do I get defensive, or curious?
- What would the client say I misunderstood?
Evidence & sources
Sources checked in October 2026, using targeted searches rather than a systematic review. “We have not located” means our searches did not find it.
Testimonial injustice, where a speaker is given less credibility because of prejudice about who they are, comes from Miranda Fricker, Epistemic Injustice: Power and the Ethics of Knowing (Oxford University Press, 2007). Applying it to disabled people’s accounts of their bodies is a common move in disability studies and this site’s reading.
Epistemic trust in therapy is discussed in Fonagy, P. & Allison, E. (2014), “The role of mentalizing and epistemic trust in the therapeutic relationship”, Psychotherapy. doi:10.1037/a0036505. It is a theoretical proposal, not a tested treatment.
The trauma-informed principles of safety, trustworthiness and transparency, peer support, collaboration, empowerment and choice, and attention to cultural, historical and gender issues are set out in SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach (US Department of Health and Human Services, 2014). This is guidance for services, not a tested therapy.
The side-by-side comparison, the “what it can miss” notes, the Mine, Yours, Ours, System mapping and the “what earns trust” list are this site’s synthesis for teaching. They are not a validated method.
Sinéad and the dialogues are constructed for learning. They are not real people or real sessions.
We have not located research on how therapists can best rebuild trust with disabled clients who have experienced medical disbelief, or comparing approaches for doing so.